| NPI | 1063161818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1026134) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101279659) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2026-05-02 |